Several factors influence the risks and cardiac screening practices, including: a cardiac murmur, the patient's sports activities, and an ECG with modifications of uncertain significance. We refer to a cardiologist for an opinion a child with a murmur, especially if engaged in strenuous sports activities, and an ECG abnormality of uncertain significance. Patients with a structural heart defect or prolonged QT interval are excluded from drug therapy for ADHD and are offered behavioral and alternative therapies.